Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $176.25 / $201.26 / $444.81	Facility	26	$176.25	$201.26	$444.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $254.55 / $438.26 / $718.82	Professional		$254.55	$438.26	$718.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.45 / $105.75 / $294.50	Professional	26	$79.45	$105.75	$294.50
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $593.91 / $593.91 / $593.91	Professional	50	$593.91	$593.91	$593.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $171.62 / $317.89 / $508.96	Professional	TC	$171.62	$317.89	$508.96
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $101.96 / $101.96 / $101.96	Facility	26	$101.96	$101.96	$101.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $357.33 / $619.59 / $977.82	Professional		$357.33	$619.59	$977.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $87.50 / $159.22 / $259.61	Professional	26	$87.50	$159.22	$259.61
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $267.48 / $468.47 / $731.21	Professional	TC	$267.48	$468.47	$731.21
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $647.95 / $731.93 / $891.32	Professional		$647.95	$731.93	$891.32
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $169.98 / $195.67 / $228.55	Professional	26	$169.98	$195.67	$228.55
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $472.74 / $537.09 / $662.77	Professional	TC	$472.74	$537.09	$662.77
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $540.54 / $630.63 / $1,024.74	Professional		$540.54	$630.63	$1,024.74
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $141.97 / $180.90 / $270.42	Professional	26	$141.97	$180.90	$270.42
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $382.67 / $545.01 / $760.70	Professional	TC	$382.67	$545.01	$760.70
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $132.30 / $175.21 / $180.90	Facility	26	$132.30	$175.21	$180.90
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $155.88 / $155.88 / $270.36	Professional		$155.88	$155.88	$270.36
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $108.54 / $162.00 / $187.01	Professional	26	$108.54	$162.00	$187.01
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $308.27 / $489.10 / $667.29	Professional	TC	$308.27	$489.10	$667.29
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $101.96 / $101.96 / $101.96	Facility	26	$101.96	$101.96	$101.96
Providence Facility/Professional Professional Modifier Low / Median / High Price $522.65 / $748.75 / $972.73	Professional		$522.65	$748.75	$972.73
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $89.86 / $160.88 / $259.61	Professional	26	$89.86	$160.88	$259.61
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $267.48 / $468.47 / $758.28	Professional	TC	$267.48	$468.47	$758.28
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $851.78 / $851.78 / $851.78	Facility	26	$851.78	$851.78	$851.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $603.29 / $746.32 / $955.08	Professional		$603.29	$746.32	$955.08
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $159.19 / $189.61 / $252.04	Professional	26	$159.19	$189.61	$252.04
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $444.09 / $568.94 / $703.05	Professional	TC	$444.09	$568.94	$703.05
United Facility/Professional Professional Modifier Low / Median / High Price $306.27 / $494.25 / $1,072.40	Professional		$306.27	$494.25	$1,072.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $81.59 / $118.53 / $274.94	Professional	26	$81.59	$118.53	$274.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $223.90 / $350.60 / $767.96	Professional	TC	$223.90	$350.60	$767.96